RN II, Care Manager

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Execute registered nurse responsibilities for the Primary Nurse population by adhering to established guidelines to guarantee an appropriate level of care.

• Strategize transitions to the continuum of care and create member-focused care plans.

• Reach out to high-risk members and engage them in preventive care opportunities and screenings.

• Assess members' clinical needs in accordance with established guidelines and standards.

• Facilitate responses to care gaps and identify high-risk members.

• Evaluate the necessity, appropriateness, and efficiency of medical services and procedures.

• Develop, coordinate, and support the implementation of personalized care plans.

• Collaborate with members, families, physicians, hospitals, and external stakeholders.

• Ensure high-quality, cost-effective care across the continuum, including transitional care.

• Monitor medical care activities and outcomes for their appropriateness and effectiveness.

• Advocate for members and families throughout various care sites.

• Promote participation and adherence to case/disease management programs.

• Accurately and comprehensively document according to established standards and policies.

• Communicate with multidisciplinary teams via telephone and/or in person.

• Evaluate care, analyze variances, and engage in quality improvement initiatives.

• Mentor and train newly hired RNs and other staff members.

• Present clinical cases during audits performed by external review organizations.

⛳️ Requirements

• An associate's or bachelor's degree (or higher) in nursing or a health-related field, or an accredited nursing diploma is required.

• A minimum of two (2) years of clinical experience is required.

• At least three (3) years of experience in the healthcare delivery system/industry is required.

• Preference for candidates with experience in both acute and chronic conditions.

• Strong preference for candidates with healthcare payer experience.

• An active Unrestricted RN License is required; NJ License is preferred.

• A valid Driver's License and Insurance are required.

• Proficiency in personal computers and software in a Windows-based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook.

• Familiarity with case/care/disease management principles is required.

• Understanding of utilization, case, and/or disease management processes is essential.

• Basic knowledge of principles of utilization management is necessary.

• Basic understanding of healthcare contracts and benefit eligibility requirements is preferred.

• Knowledge of hospital structures and payment systems is required.

• Bi-lingual proficiency is preferred.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous PTO.

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.